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General NPI Number Information
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NPI Number | 1003531914
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Entity Type | Individual
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Provider Name | MARCO EVANGELISTA PHARMD
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Gender | Male
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Dates
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Enumeration Date | 10/04/2022
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | 2014 S BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19145-2305
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Country | US
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Telephone | 215-551-3818
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Fax |
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Provider Business Mailing Address
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Address Line | 848 AGNES AVE
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City | MORTON
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State | PA
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Zip | 19070-1818
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP456625
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License Number State | PA
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